Contact Information
Child's Information
State
Parent Information
I/we are signing this child up for:
In case of emergency contact:
Health Information
If a serious illness or accident occurs while with the Pioneer Clubs, Cadets, GEMS, The Rock, The Summit, or REACH Co-Op and neither parent can be located, permission is given to take my child to the emergency room (provide a name and address below), or the nearest hospital.
Emergeny Hospital
Consent for Emergency Treatment Form
In the event of an emergency situation in which medical treatment is required as a result of participation with any First Christian Reformed Church youth event (Pioneer Clubs, Cadets, GEMS, The Rock, The Summit, REACH Co-Op), every reasonable effort will be made to contact the persons listed on the Family/Participant Information Form. If unsuccessful in contacting the persons listed, consent/permission is given for treatment by competent medical personnel.
Further, and unless specified otherwise, consent/permission is hereby given to all accompanying adult volunteer leaders associated with our youth ministry to hospitalize, secure proper treatment for, and to order any x-ray examination, injection, anesthesia, or surgery (under recommendation of qualified medical personnel).
I, the undersigned, who by law may do so, authorize the administration of emergency medical treatment to s/he who is the subject of this form. I understand that all reasonable safety precautions will be taken at all times by the leadership of the First CRC Pioneer Clubs / Cadets / GEMS / The Rock / The Summit / REACH Co-Op program or its associates liable for any accident, injury or disease incurred by the subject of this form. I understand that in the event that medical intervention is needed every attempt will be made to contact the person(s) listed immediately.
I, the undersigned, also authorize the participation of the subject of this form in all activities relating to the programs sponsored by the following: Pioneer Clubs, Cadets, GEMS, The Rock, The Summit, and REACH Co-Op ministries of First Christian Reformed Church. I understand that this form is effective for the duration of the program year and by allowing my child(ren) to attend I acknowledge this release form. I understand that it is my responsibility to provide any updates to this information to the Head Counselor or Director of Youth Ministries during my child’s participation throughout the program year.
PROMOTIONAL MATERIALS RELEASE
Throughout the year, Pioneer Clubs, GEMS, Cadets, The Rock, The Summit, and REACH Co-Op activities provide great photo opportunities to promote our church. Publications for promotional, recruitment and/or fundraising, etc. purposes might include newspaper articles, DVD/website images, slides, audiotapes or other audio-video reproduction. Individual and/or group shots may include your child.
By signing this form, I release the staff and volunteers of these student ministries of First Christian Reformed Church from any liability connected with the use of these materials as mentioned above.
My child MAY be included in First CRC’s promotional material
LIABILITY WAIVER
In order for your child to participate in any on or off-site church (Pioneer Clubs / GEMS / Cadets / The Rock / The Summit / REACH Co-Op) related activity (e.g. sporting event, bowling, laser tag, shopping, etc.), a parent/guardian will need to complete the waiver below.
It is the intention of
the parent/guardian of
by this agreement to exempt and relieve First Christian Reformed Church, its officers, agents, staff, leaders and volunteers from liability for personal injury, property damage, or wrongful death caused by any act of negligence during any on or off-site, church/club-related activity during the 2023-2024 program year. For and in consideration of permitting above mentioned minor to observe or use any facility or equipment of First Christian Reformed Church, or engage in and/or receive instruction in any activity or activity incidental thereto, some of which may involve dangers and risk of bodily injury at First Christian Reformed Church, I hereby voluntarily and absolutely release, discharge, waive, and relinquish any and all loss of damages or actions or causes of actions for personal injury, property damage, or wrongful death. The undersigned parent or guardian of above mentioned minor for him/herself, his/her heirs, executors, administrators, or assigns agrees that in the event any claim for personal injury, property damage, or wrongful death shall be prosecuted against First Christian Reformed Church, or its officers, agents, staff, leaders, and volunteers, the undersigned parent or guardian will indemnify and hold harmless First Christian Reformed Church its officers, agents, servants, or employees from any and all claims or causes of action by above mentioned minor or by any other person or entity, by whomever or wherever made or presented, and under no circumstances will the undersigned parent or guardian of above mentioned minor present any claim against First Christian Reformed Church and said persons for personal injuries, property damage, wrongful death, or otherwise, caused by any act of negligence by First Christian Reformed Church and said persons.
The undersigned parent or guardian represent that he/she has read this Release, has requested and has been provided with, or has requested and declined advisement on the potential dangers/risks of engaging in the observation, activities, or instruction offered, assumes all risks associated with such dangers and risks, and is fully aware of and understands the terms and the legal consequences of the signing of this Release. The undersigned parent or legal guardian intends his or her signature to be a complete and unconditional release of all liability to the greatest extent allowed by law and if any portion of the Release is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.